Orthodontic Services in support of the Non-Insured Health Benefits (NIHB) Program

NOTICE OF PROPOSED PROCUREMENT (NPP) 

Description of the Requirement:
Provinces and territories are responsible for delivering health care services, guided by the provisions of the Canada Health Act. Health care services include insured hospital care and primary health care, such as physicians and other health professional services. Like any other resident, First Nations people and Inuit access these insured services through provincial and territorial governments.

However, there are a number of health-related goods and services that are not insured by provinces and territories or other private insurance plans. To support First Nations people and Inuit in reaching an overall health status that is comparable with other Canadians, the NIHB Program provides coverage for a limited range of these goods and services when they are not insured elsewhere.

The NIHB Program is a national, medically necessary health benefit program that provides coverage for benefit claims for a specified range of drugs, dental care, vision care, medical supplies and equipment, mental health counselling and medical transportation for eligible First Nations people and Inuit.

The NIHB Program's dental benefit covers dental services, including: diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral surgery, orthodontic and adjunctive services.
Objective:
The Dental Predetermination Center (DPC), orthodontic services assesses orthodontic requests for eligible clients from all regions. Coverage of orthodontic treatment will be considered when all established orthodontic policy, guidelines, and criteria are met. A three (3) step appeal process exists to provide a mechanism for examining cases after they were denied at the initial review.
Scope:
Initial Review is the initial adjudication of the diagnostic records and additional information provided by the NIHB Client and/or Service Provider. Recommendations are based on the information submitted and provided against the established Program policy, guidelines, and criteria. 
 
Level One (1) Appeals are the first re-evaluation of the diagnostic records and additional information provided by the NIHB Client and/or Service Provider. Recommendations are based on the information submitted and provided against the established Program policy, guidelines, and criteria. Final decisions at level 1 appeal are taken by the Director of the Dental Policy Development Division (DPDD).
 
Level Two (2) Appeals are the second re-evaluation of the diagnostic records and additional information provided by the Client and/or Service Provider. Recommendations are based on the information submitted and provided against the established Program policy, guidelines, and criteria. Final decisions at level 2 appeal are taken by the Director of the Benefit Management and Review Services Division (BMRSD).
 
Level Three (3) Appeals are the final re-evaluation of the diagnostic records and additional information provided by the Client and/or Service Provider. Recommendations are based on the information submitted and provided against the established Program policy, guidelines, and criteria. Final decisions at the third and final level of appeal are taken by the Director General of NIHB.
 
Deliverables
The Contractor will complete and submit in writing one (1) copy of the recommendation to a Project Authority or its delegated representative using the templates and forms provided by the DPC, orthodontic services. The exact format and timing for the provision of the professional advice and other services described in section 2.2 & 3.2 will be determined in advance by the Project Authority or its delegated representative.
Level of Security Requirement: 
Pursuant to the Policy on Government Security, the nature of the services to be provided under the Contract requires a valid Government of Canada (GoC) personnel Security Screening at the level of Reliability Status for the Contractor, authorized resources and sub-contractors to be assigned to conduct the work.
Prior to the commencement of the work, the Contractor and each authorized resources involved in the performance of the work under this contract must EACH, hold a valid Security Screening at the level of Reliability Status.
Estimated Level of Effort:

STREAM 1 -3 Resources required
Initial Contract Period
The workload expected for each Contractor is estimated at 93 days for a period of 3 year.
Option year periods 
The workload expected for each Contractor is estimated at 124 days for a period of 4 year.

STREAM 2 -2 Resources required
Initial Contract Period
The workload expected for each Contractor is estimated at 30 days for a period of 3 year.
Option year periods 
The workload expected for each Contractor is estimated at 40 days for a period of 4 year.

STREAM 3 -2 Resource required
Initial Contract 
The workload expected for each Contractor is estimated at 11.19 days for a period of 3 year.
Option year periods 
The workload expected for each Contractor is estimated at 14.92 days for a period of 4 year.

File Number: 1000225714
Contracting Authority: Jean-Damascene Gasake
Phone Number: 873-354-5730
E-Mail: jeandamascene.gasake@canada.ca